Not all dermatitis can be diagnosed as atopic dermatitis or atopic eczema
In addition, in atopic dermatitis the skin manifestations are characteristic and vary according to the age of the person and are decisive for the clinical diagnosis. But first of all, there must be atopy.
What is atopy?
Atopy is a biological condition and is the inherent feature of the disease that differentiates it from all other forms of dermatitis such as allergic contact dermatitis or irritant dermatitis. Therefore, only if this condition exists can a specific skin inflammation be diagnosed as atopic dermatitis. The term atopy refers to a personal or familial hypersensitivity of the skin and/or mucous membranes to common environmental stimuli that results in increased production of IgE and the development of symptoms such as conjunctivitis or asthma or skin manifestations such as eczema.
Three important elements emerge from the above definition:
Familiarity: refers to the presence of atopic diseases in relatives of the person with atopic dermatitis because there is a genetic predisposition. Studies have shown alterations in chromosomes 3, 5, and 11 and the presence of atopic dermatitis in 80% of homozygotic twins, as identical twins share the same DNA, and only 30% of heterozygotic twins. In addition, a defect in a specific skin protein, filaggrin, has recently been demonstrated, an alteration also present in common ichthyosis. Hypersensitivity of the skin or mucous membranes: various substances, chemical, natural, biological, are capable of triggering a series of diseases, called atopic, such as bronchial asthma, rhinitis or conjunctivitis. Therefore, in a given household, one person may suffer from bronchial asthma and another from atopic dermatitis. Apparently different diseases whose common denominator is atopy, which is clinically expressed in different ways in different people. Overproduction of IgE: increased serum IgE antibodies as a biological defense response to various potential triggers and irritants or as a consequence of an allergy that the person with atopic dermatitis may have developed. I emphasize that atopic dermatitis is not an allergy but could develop it as mentioned below.
Clinical manifestations of atopic dermatitis
A person is born with atopic dermatitis, a constitutive defect in the outer layer of the skin, the epidermis, where there is a defect in the skin barrier that protects us every day from external aggression. This barrier defect is due to a quantitative and qualitative change in certain lipid substances (cholesterol, essential fatty acids, ceramides), which are normally placed between the keratinocytes, and to a defect in filaggrin. The outermost layer of the skin can be compared to the plaster of a wall, which only if intact can preserve the bricks from atmospheric agents. Likewise, only if the barrier function is intact is our skin able to deal with external aggression, for example from the chemicals in a detergent. Damage to the barrier facilitates the penetration of irritants, capable of activating inflammatory and immune processes typical of atopic dermatitis, which, as mentioned, manifest differently in different age groups. Infant: the initial manifestation is a yellowish scaling found on the scalp, called milky scab, which when present does not necessarily imply a diagnosis of atopic dermatitis as it could be only a separate manifestation. The medical history alone could lead one to suspect atopic dermatitis if there is a family history of atopy. The first two years: patches of eczema selectively located on the cheeks, forehead, chin with the perioral area free. In addition to the face, the trunk and the extensor surface of the limbs can also be affected. The patches are well defined and erythematous in color, covered with scales and serous crusts. When the dermatitis is particularly widespread, lymphadenopathy, that is, an increase in the size of the lymph nodes, may occur. For example, if dermatitis is present on the face, the submandibular or postauricular lymph nodes may be enlarged. Childhood and adolescence: dermatitis occurs in the folds of the elbows, wrists, neck, behind the ears, knees and back of the hands. Given the location, cracks can often be seen, sometimes painful. Adults: The affected parts are similar to the previous ones, but in this case the scrotum, ankles and neck may also be affected. Itching, an ever-present symptom in atopic dermatitis Itching is the ever-present symptom. There is no atopic dermatitis without itching, which if particularly intense causes the person to scratch, favoring the formation of scratchy lesions but also the appearance of lichenification, a rough grayish thickening characterized by an accentuation of the normal texture of the skin surface with consequent loss of plasticity of the skin. In addition, it can be a cause for concern as it can hinder a person’s sleep.
Complications
Bacterial infections are very common, but so are viral or fungal infections. In the first case, Staphylococcus aureus can cause wax in atopic dermatitis patches that become moist and exudative, covered with yellowish crusts. Herpes simplex and herpes zoster are the most common causes of viral infections along with molluscum contagiosum. Finally, regarding fungal infections, P. ovale is responsible for the persistence of atopic dermatitis patches on the upper third of the trunk in young women.
Development and triggering factors of atopic dermatitis
Relapse is the main feature of atopic dermatitis, which tends to improve in summer and then worsen in autumn and winter, caused by various factors
aggressive and particularly foaming detergents. irritating clothing made of synthetic fibers or wool. profuse sweating; infectious episodes; vaccinations; powder; stressful emotional factors.
Most people with atopic dermatitis tend to improve after puberty, while maintaining easily irritated skin. However, between 5 and 50% of patients continue to suffer from atopic dermatitis as adults.
Treatment
Treatment is based on the severity of the disease as assessed by the prescribing physician using certain scales that take into account the severity of the signs and/or symptoms of the disease. Treatment in mild forms of atopic dermatitis is topical treatment, which includes the use of emollients to soothe dry skin, cortisone or calcineurin inhibitors during the inflammatory phase, and antibiotics only if there is an infection. Only in severe cases is systemic therapy indicated, including cortisone, cyclosporine, or dupilumab. In addition to these, phototherapy is a valuable aid in the treatment of atopic dermatitis. A possibly European expert panel has drawn up the 2019 guidelines for a critical and timely approach to atopic dermatitis.
Read also:
Emergency Live Even More…Live: Download your new free newspaper app for IOS and Android Atopic Dermatitis: Treatment and Cure Psoriasis, a disease that affects the mind as well as the skin Allergic contact dermatitis and atopic dermatitis: the differences Adverse drug reactions: What they are and how to manage them Symptoms and treatments of allergic rhinitis Allergic conjunctivitis: Causes, symptoms and prevention What is and how to read the allergy test Eczema or cold dermatitis: Here’s what to do Psoriasis, an ageless skin disease
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